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AMHERST, Mass. – Results of a new study of factors that affect substance abuse and health among women military veterans who use the Department of Veterans Affairs (VA) for health services suggest that delivering health and social services to them could be improved if several factors are taken into account, such as their history of trauma, discrimination and post-military socio-economic stress, among others.

Lead author Elizabeth Evans at the University of Massachusetts Amherst, with colleagues at the VA Greater Los Angeles Healthcare System and the University of California, Los Angeles, say their findings can help to improve interventions and services to reduce the womens’ vulnerability to substance abuse and other health risks. Women veterans are the fastest growing segment of the nation’s veteran population, they note.

As Evans and colleagues explain, women veterans who use the VA have high rates of substance abuse and poorer health than non-veteran women. “Women vets are a vulnerable but underserved population,” she and colleagues point out. “We aimed to understand the health status, health care needs, experiences, and preferences of women Veterans being treated in community settings.”

Using a mixed-methods study design, the researchers conducted semi-structured, in-person interviews with 22 women veterans in Los Angeles in 2013-15. Semi-structured interviews include a group of pre-set, open-ended questions to spark discussion but they also allow the interviewer a chance to further explore particular responses.

The 22 women who participated in this study were 29 to 57 years old and represented all branches of the military. About 36 percent were African-American, 23 percent white, 18 percent Hispanic/Latina, 18 percent biracial and 5 percent Pacific Islander. Most had some college education but most were also unemployed. Most of the women, 55 percent were uninsured and relied only on VA for health care.

The authors say the current health of these women veterans has been shaped by substance abuse and several other factors, including histories of trauma in childhood or during military service, discrimination, other associated mental health conditions, post-military socio-economic stressors, shifting social roles and adverse social support, and lost personal identity after military service. Such factors put them at increased risk for depression, substance abuse and thoughts of suicide.

Although the VA has worked to change its historically male-dominated health care system to one more sensitive and appropriate to women’s needs, only a minority of women veterans use the VA for their health care, the researchers say. Women may not know the services are available, may have negative perceptions about VA care, or they may have private insurance. Little is known about women veterans who seek care in community-based, non-VA settings, they add.

Services to women vets could be improved by offering them gender-sensitive substance abuse treatment, by addressing traumas that contribute to poor health, recognizing how stress prevents women’s ability to access health care or cope with stress in healthy ways, and by championing women veterans who are resilient and enlisting them to help others toward health and wellness.

In this study, “Women reflected on factors that led to their current mental health status, revealing that experiences of childhood adversity were common,” the authors report. Many said their decision to join the military was related to early life adverse family and social conditions. Many said they expected that joining the military would provide access to better opportunities.

Evans and colleagues recommend increasing awareness among veterans and active service members that alcohol and other substance use is an unhealthy coping strategy. “Also, it is important to recognize that exit from active duty may be a high-risk time period when women are more likely to increase substance use or switch from alcohol to use of marijuana, stimulants, opioids or other types of substances,” they add.

The researchers also recommend creating an environment in which a veteran seeking help for substance abuse recovery is supported and encouraged, not penalized. Staff and clinicians at the VA and in community-based settings “are likely to be unaware of women veterans’ substance abuse problems,” they point out, and may miss the chance to suggest treatment.

This work was supported by the UCLA AIDS Institute and a Health Services Research and Development Advanced Postdoctoral Fellowship at the Center for the Study of Healthcare Innovation, Implementation and Policy, and by Greater Los Angeles Veterans Affairs.